National Institute on Drug Abuse, Bethesda, Maryland, USA.
University of Miami, Miami, Florida, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e1982-e1990. doi: 10.1093/cid/ciaa838.
Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation.
CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression.
Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P < .001).
Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.
研究表明，在人类免疫缺陷病毒（HIV）检测当天或首次临床就诊时开始抗逆转录病毒治疗（ART）可带来益处。目前，医院环境中对立即开始 ART 的研究较少。
CTN0049 是一项衔接至护理的随机临床试验，在美国 11 家医院招募了 801 名患有 HIV 和物质使用障碍的患者。本二次分析评估了在医院开始（包括重新开始）ART 的相关因素及其与衔接至 HIV 护理、门诊就诊频率、保留和病毒抑制的关联。
在 801 名参与者中，有 124 名（15%）在医院开始接受 ART，其中超过三分之二的参与者（80/124）首次开始接受 ART。在医院开始接受 ART 的参与者和未在医院开始接受 ART 的参与者首次接受 HIV 护理就诊的时间分别为 29 天和 54 天（P=0.0145）。在医院开始接受 ART 与 6 个月和 12 个月时 HIV 门诊就诊频率增加相关。在 12 个月期间，在医院开始接受 ART 与保留和病毒抑制无关。在南部医院招募的参与者在医院开始接受 ART 的可能性较低（P＜0.001）。
先前的研究表明立即开始 ART 的益处，但这种方法并未广泛实施。研究结果表明，在医院开始接受 ART 有利于增加 HIV 护理的衔接和 HIV 和物质使用障碍患者的就诊频率。实施研究应解决在医院尽早开始接受 ART 的障碍。
